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Applied Neuropsychology. Adult Jun 2023Neuropsychologists use performance validity tests (PVT) to detect performance invalidity across various populations. Unexpected scores for normative and clinical...
Neuropsychologists use performance validity tests (PVT) to detect performance invalidity across various populations. Unexpected scores for normative and clinical populations on PVT performance could invalidate the assessment if the poor performance does not have a reasonable explanation. One of the most well-validated and frequently used PVT is the Test of Memory Malingering, whose usefulness has been analyzed in various populations, including the military. Studies on the influence of demographic variables and blast exposure on the performance of military samples have yielded inconclusive results. The current study investigates the influence of age, education, and blast exposure on the TOMM Trial 2 in a military sample that is representative of their demographics. The total sample size was 872 participants between 18-62 years of age ( = 26.35, = 6.63), divided into 832 males and 40 females. All participants were on active duty, and they had been deployed in war zones in Afghanistan and Iraq. They were referred to Carolina Psychological Health Services from the Naval Hospital of Camp LeJeune for psychological and/or neurological complaints, such as cognitive difficulties. The results show that age, education, and blast exposure variations do not affect TOMM performance. Further studies on the relationship between these variables should be pursued to elucidate how they are associated with the normative or clinical cognitive functioning of military populations.
PubMed: 37358239
DOI: 10.1080/23279095.2023.2227909 -
Cureus May 2023In reality, the lines between factitious disorder, functional disorder, and malingering are quite blurred. In factitious disorder and malingering, patients consciously...
In reality, the lines between factitious disorder, functional disorder, and malingering are quite blurred. In factitious disorder and malingering, patients consciously and deliberately create false medical and/or psychiatric symptoms for self-gain, often approaching multiple healthcare facilities to evade detection. Although the factitious disorder is pervasive, and the literature lacks accurate and consistent information, comorbidity with nonepileptic seizure (NES, a component of functional disorder) is quite commonly documented. In our case, the patient feigned multiple symptoms including two seizures and a shoulder dislocation to gain access to opioids. The clinical picture was only significant for alcohol withdrawal, aspiration pneumonia (possibly intubation vs. NES-related), and self-induced shoulder dislocation. Generally, management of these disorders should involve multiple specialties, multiple approaches, and identifying the triggering and comorbid psychological disorders, such as abandonment issues, personality disorders, physical or emotional abuse, anxiety, depression, stress, and substance use. Blindly approaching patients with a factitious disorder or malingering will not lead to any productive outcomes. Perhaps, creating a patient database could help reduce futile efforts while providing patients with the required help. This case report describes the presentation, diagnosis, management, and outcomes related to a patient with NES, engaging the reader to decipher the most appropriate diagnosis.
PubMed: 37332451
DOI: 10.7759/cureus.39197 -
Journal of Clinical Neuroscience :... Aug 2023Functional Neurologic Disorders (FND) are a common but heterogeneous group of disabling conditions. The Emergency Department (ED) is an important venue for care and...
BACKGROUND
Functional Neurologic Disorders (FND) are a common but heterogeneous group of disabling conditions. The Emergency Department (ED) is an important venue for care and referral as it is often the first point of contact when patients with FND are faced with a crisis or exacerbation of symptoms.
METHODS
ED providers (n = 273) practicing in the Cleveland Clinic Foundation Northeast Ohio network were invited to participate through secure web application electronic surveys. Data were collected on practice profiles, knowledge, attitudes, management of FND, and awareness of available resources for FND.
RESULTS
Sixty providers completed the survey (22% response rate; n = 50 ED physicians, 10 advanced care providers) with 95.0% (n = 57) reporting a lack of understanding about FND. The terms Psychogenic Nonepileptic Seizures and stress induced/stress related disease were used by 60.0% (n = 36) and 58.3% (n = 35) respectively. Ninety percent (n = 53) rated their experience with managing FND patients as at least more difficult. Eighty- five percent (n = 51) agreed with "rule out others" and 60% (n = 36) agreed with "caused by psych stress". Eighty six percent (n = 50) believe that there is a difference between FND from malingering. Only one respondent was familiar with any FND resources and 79% (n = 47) reported the need for FND specific educational materials.
CONCLUSION
This survey revealed major gaps in knowledge, inaccurate perceptions, and management that differs from the current standard of care among ED providers caring for patients with FND. Educational opportunities are needed to guide diagnosis and evidence-based treatment to optimize management of patients with FND.
Topics: Humans; Nervous System Diseases; Conversion Disorder; Psychophysiologic Disorders; Emergency Service, Hospital
PubMed: 37329664
DOI: 10.1016/j.jocn.2023.06.008 -
The Clinical Neuropsychologist Feb 2024The objective of the current investigation was to validate and establish the psychometric properties of an abbreviated, 10-item version of the Word Choice Test (WCT)....
The objective of the current investigation was to validate and establish the psychometric properties of an abbreviated, 10-item version of the Word Choice Test (WCT). Data from one hundred ten clinically-referred participants (M age = 55.92, SD = 14.07; M education = 13.74, SD = 2.43; 84.5% Male) in a Veterans Affairs neuropsychology outpatient clinic was analyzed. All participants completed the WCT, the TOMM T1, the WMT, and the Digit Span subtest of the WAIS-IV as part of a larger battery of neuropsychological tests. Correlation analyses revealed significant relationships between the 10-item WCT-10, the TOMM T1, the RDS forward/backward, as well as the IR, DR, and CNS subtests of the WMT. ROC analysis for the WCT-10 indicated optimal cutoff of 2 or more errors, with 52% sensitivity and 97% specificity (AUC=.786, <.001), compared with the standard administration of the WCT with a cutoff of 8 or more errors, which had 67% sensitivity and 91% specificity. Specificity/sensitivity values remained adequate at a cutoff of two or more errors when participants with cognitive impairment (Sensitivity=.52, Specificity=.92) and without cognitive impairment (Sensitivity=.52, Specificity = 1.0) were examined separately. The present investigation revealed that the WCT-10, an abbreviated free-standing PVT comprised of the initial 10 items of the WCT, demonstrated clinical utility in a mixed clinical sample of Veterans and was robust to cognitive impairment. This abbreviated PVT may benefit researchers and clinicians through adequate identification of invalid performance while minimizing completion time.
Topics: Humans; Male; Middle Aged; Female; Neuropsychological Tests; Psychometrics; Sensitivity and Specificity; ROC Curve; Educational Status; Reproducibility of Results; Malingering
PubMed: 37266928
DOI: 10.1080/13854046.2023.2218576 -
Nature Reviews. Neurology Jun 2023
PubMed: 37193749
DOI: 10.1038/s41582-023-00821-2 -
Military Medicine Aug 2023A positive therapeutic relationship is characterized by trust and mutually perceived genuineness. It is positively associated with patients' adherence to treatment,...
INTRODUCTION
A positive therapeutic relationship is characterized by trust and mutually perceived genuineness. It is positively associated with patients' adherence to treatment, satisfaction, and health outcomes. When service members with a history of mild traumatic brain injury (mTBI) present to rehabilitation clinics with nonspecific symptoms, a disparity between their experience of disability and clinical expectations of mTBI may disrupt the establishment of a positive therapeutic relationship between patients and providers. The objectives of this study are to (1) explore disparities between military service members and rehabilitation clinicians about the clinical diagnosis and illness experience of mTBI and (2) identify barriers to the establishment of a positive therapeutic relationship.
MATERIALS AND METHODS
This is a qualitative descriptive study of military service members with prior mTBI (n = 18) and clinicians (n = 16) who participated in interviews and focus groups. Data were analyzed thematically using Kleinman's framing of illness experience and clinical diagnosis.
RESULTS
Three themes reflected the potential breakdowns in the therapeutic relationship. The first theme, clinical expectations for post-injury recovery versus patients' experience of ongoing disability, reflects the inconsistency between clinicians' expectations of symptom resolution within 90 days following mTBI and service members' experiences of symptoms that worsened over several months or years. The second theme, symptom attribution to mental health conditions versus tissue injury, describes the difficulty in attributing symptoms to the physical impact of the mTBI or mental health diagnoses that may also stem from the injury event. The third theme, suspected malingering versus valid disability, describes clinicians' reports of frustration with cases in which they suspected malingering for secondary gains in contrast with service members' feelings that their problems were not taken seriously by clinicians.
CONCLUSIONS
This study extended previous research on therapeutic relationships by examining the situation of mTBI rehabilitation services for military service members. The findings reinforce the best practice recommendations of acknowledging patients' experiences, addressing the presenting symptoms and problems, and encouraging progressive return to activity following mTBI. Acknowledgment of and attention to patients' illness experience by rehabilitation clinicians is necessary and important for supporting a positive therapeutic relationship and ultimately to optimize patients' health outcomes and reduce disability.
Topics: Humans; Brain Concussion; Military Personnel
PubMed: 37192051
DOI: 10.1093/milmed/usad143 -
Revista Brasileira de Psiquiatria (Sao... May 2023To identify under what circumstances a university student should be allowed academic accommodation for ADHD. To frame an evidence-based policy for use in Brazil based on...
OBJECTIVE
To identify under what circumstances a university student should be allowed academic accommodation for ADHD. To frame an evidence-based policy for use in Brazil based on a worldwide experience.
METHODS
We reviewed the literature to acquire information on what documents are commonly required by disability services before accommodation for ADHD is made (including malingering detection). We scrutinized the eligibility criteria of the best universities worldwide. Renowned experts in the field and national stakeholders were consulted.
RESULTS
We found no international standard for the assessment of students with ADHD who request academic accommodation. Even renowned institutions worldwide differ from one another in their approaches to academic accommodation on the grounds of ADHD. We propose a national unified set of criteria for Brazilian universities, which could generalize internationally.
DISCUSSION
Rigorous assessment is paramount for aiding students with disabilities while preventing ineligible students gaining an unfair advantage. Higher education institutions nationwide and beyond may benefit from adopting a unified set of criteria for eligibility to ADHD accommodation programs.
PubMed: 37127329
DOI: 10.47626/1516-4446-2022-2999